Unit of Forensic Medicine

In case of of homicide, or other criminally suspicious deaths, and upon request of the prosecutor’s office, the forensic pathologist’s work usually begins at the scene of death with an external examination of the victim’s body. The body is then taken to the medico-legal institute where a more thorough external examination of the corpse is performed. The body may also be radiographically imaged. Then an autopsy is carried out. When all of the information including the history, the results of the autopsy and the laboratory tests (toxicology, genetics, histopathology, etc) are completed, the forensic pathologist correlates all the information and draws conclusions as to the cause, mechanisms and manner of death. A report is then prepared summarizing these findings.

In the case of living persons, he may be required to examine the victims of physical or sexual assault or provide an expert evaluation. He also analyses case documents. Lastly, he is frequently called upon to testify in court cases.

2. How do I become a forensic expert?

To become a forensic pathologist you must obtain the federal doctor’s diploma (6 years of medical studies), as well as experience required by the Swiss Medical Association (FMH) for training as a specialist in legal medicine (mainly autopsies, clinical examinations and expert evaluations). This specialization lasts 5 years, of which four are spent in an approved legal medicine training establishment.

3. Is it necessary to study law as well as medicine ?

Training as a forensic pathologist includes studying the basics of law and judicial procedures. However, candidates are not required to obtain a qualification in law as such.

4. Who does the forensic expert work for ?

Forensic pathologists work mainly under the mandate of an authority such as the Prosecutor’s office or the police. More rarely, they respond to requests from private individuals or institutions, such as insurance companies or NGOs for example.

5. Who asks for an autopsy to be carried out ?

Medico-legal autopsies are requested by the prosecutor’s office. In the particular case of the canton of Geneva, they may also be requested by the police.

Medical autopsies are requested by doctors who treated the patient, after approval has been given by the family and in the absence of prior instructions on the part of the deceased.

6. What is the difference between a medical autopsy and a medico-legal autopsy ?

The purpose of an autopsy is to determine the cause(s) of death.

For medical autopsies, death is natural. The autopsy is carried out by an approved pathology service, after approval of the family and in the absence of prior instructions on the part of the deceased, so that doctors who treated the patient can establish the cause of death.

For medico-legal autopsies, the suspicion exists that death was not natural. Any obstacle to burial is noted on the certified report of death and the prosecutor requests an autopsy to throw light on the causes and circumstances of the death (homicide, suicide, accident, etc, cf. question 7). This is generally carried out by an institute of legal medicine.

7. In what cases is a medico-legal autopsy carried out ? And a medical autopsy ?

A medico-legal autopsy is normally carried out in all cases where death is violent or suspect: homicide, sudden unexpected death, suspicion of ill-treatment, suicide, medical error, industrial disease, death in detention, unidentified body, skeletal remains, etc. At all events it is up to the prosecutor to decide whether or not a medico-legal autopsy should be performed.

A medical autopsy may be carried out in cases of death during hospitalization when doctors who treated the patient wish to find out the cause of death.

8. Can the family of a deceased person oppose an autopsy or request that one be carried out ?

The family of a deceased person cannot oppose a medico-legal autopsy. In the particular case of the canton of Geneva, an appeal is possible and the final decision rests with the public prosecutor. On the other hand, before a medical autopsy can be carried out, the agreement of the family is necessary, as well as the absence of prior instructions on the part of the deceased.

9. Does the forensic pathologist make known the conclusions of his autopsy to the family of the deceased ?

No, save where permitted by the authority that made the request.

10. How is an autopsy carried out ?

All medico-legal autopsies begin with a detailed external examination of the cadaver (clothing, measurements, sex, general indications of death, skin and bone lesions observed). The body may also be radiographically imaged. Computed tomography (CT), MR imaging, image guided biopsy and postmortem angiography provide additional options that traditional scalpel autopsy could not offer. The autopsy continues by opening up the body and examining it internally and this is followed by the dissection and examination of each organ. An autopsy is generally accompanied by additional investigations (toxicology, histology, biochemistry, genetics, microbiology, etc). It is completed by the drafting of a detailed report.

11. What are the means of identifying a body ?

The principles of medico-legal identification are based on the comparison of ante- and post-mortem elements (study of teeth, anatomical particularities, fingerprints, etc) or on studies of lineage (DNA identification of the subject and his/her family).

12. How is the time of death determined ?

The time elapsed since death can only be estimated and its accuracy diminishes over time. The medico-legal estimate of the time of death is based on a number of basic factors observed at the time of crime scene investigation: comparison between the body temperature and ambient temperature, assessment of rigidity of the cadaver, lividity and decomposition of the cadaver. The forensic pathologist may also have recourse to forensic entomology (study of necrophageous insects).

13. How many institutes of legal medicine are there in Switzerland ?

There are four university institutes of legal medicine in Switzerland: Basle, Bern, Zurich and the University Center of Legal Medicine (CURML) which includes the institutes of Geneva and Lausanne. There is also a hospital institute of legal medicine in Saint-Gall. Information about the Swiss forensic institutes can be found on the website of the Swiss Society of Legal Medicine.